<%@ page language="java" import="java.util.*" pageEncoding="utf-8"%>
<%@ include file="/common/base.jsp"%>
<% 
ChronicdisDao dao=new ChronicdisDao();
List<Chronicdis> list=dao.queryOjects("select * from t_chronicdis", null);

 %>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<base href="<%=basePath%>">
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport"
	content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=no" />
<meta name="renderer" content="webkit">
<link rel="stylesheet" type="text/css" href="css/styles.css">
<link rel="stylesheet" type="text/css" href="css/admin.css">
<link rel="stylesheet" type="text/css" href="third/autocomplete/jquery.autocomplete.css" />

<script type="text/javascript" src="js/jquery-1.4.4.min.js"></script>
<script type="text/javascript" src="js/admin.js"></script>
<script type="text/javascript" src="third/laydate/laydate.js"></script>
<script type="text/javascript" src="third/autocomplete/jquery.autocomplete.js"></script>
<script type="text/javascript">
</script>

</head>

<body>

	<div class="panel admin-panel">
		<div class="panel-head" id="add">
			<strong><span class="icon-pencil-square-o"></span>添加报销单</strong>
		</div>
		<div class="body-content">
			<form id="form-add" method="post" class="form-x"
				action="<%=path%>/system/ChronicInfoServlet?m=addreduct">
				<div class="form-group">
					<div class="label">
						<label>农合证号：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="" id="chronicInfoId" name="chronicInfoId"
							data-validate="required:请输入农合证号" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
						<div class="label">
							<label>就诊时间：</label>
						</div>
						<div class="field">
							<input type="date" id="treattime" name="treattime" value="2019-5-16" class="input w50"/>
							<div class="tips"></div>
						</div>
					</div>
				<div class="form-group">
					<div class="label">
						<label>花费金额：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="" id="money" name="money"
							 />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>医院票号：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="" id="hosId" name="hosId"
							 />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>报销金额：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="" id="freemoney" name="freemoney"
							 />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>审核状态：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="" id="reductstatus" name="reductstatus"
				/>
						<div class="tips"></div>
					</div>
				</div>
				
					
				<div class="form-group">
					<div class="label">
						<label></label>
					</div>
					<div class="field">
						<button id="add_btn" class="button bg-main icon-check-square-o"
							type="button">提交</button>
					</div>
				</div>
			</form>
		</div>
	</div>

</body>
</html>
